| NPI | 1649313354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD442723) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 29340) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2026-05-04 |